Description of Event or Problem · 1
PT WENT INTO RESPIRATORY DISTRESS REQUIRING INTUBATION ON 10/18/93. PT INTUBATED DURING A CODE BLUE PROCEDURE. ATTEMPTED BY HOUSE PHYSICIAN AND RESPIRATORY THERAPIST AND FINALLY INTUBATED BY ANESTHESIOLOGIST. PT ABDOMEN BECAME DISTENDED AFTER INTUBATION. SURGICAL CONSULT OBTAINED AND SURGICAL INTERVENTION ON 10/18/93 FOR REPAIR OF RUPTURED HG PERFORATION ESOPHAGEAL GASTRIC JUNCTION SECONDARY TO TEAR. PRE-OP DX = COPD. MAXIMUM LENGTH OF E-T TUBE = 12 INCHES. TEAR WAS AT THE LESSER CURVATURE E-G JUNCTION OF STOMACH AND NOT LIKELY FROM INTUBATION. PT HEMODYNAMIC STATUS AND PREDISPOSING CONDITION MAY HAVE BEEN A CAUSAL FACTOR OF THE TEAR. PT DID WELL POST-OPERATIVELY.DEVICE LABELED FOR SINGLE USE. PATIENT MEDICAL STATUS PRIOR TO EVENT: CRITICAL CONDITION. THERE WAS NOT MULTIPLE PATIENT INVOLVEMENT.INVALID DATA - ON DEVICE SERVICE/MAINTENANCE. NO DATA - REGARDING DATE LAST SERVICED. SERVICE PROVIDED BY: INVALID DATA. INVALID DATA - SERVICE RECORDS AVAILABILITY.NO IMMINENT HAZARD TO PUBLIC HEALTH CLAIMED. DEVICE USED AS LABELED/INTENDED.DEVICE WAS EVALUATED AFTER THE EVENT. METHOD OF EVALUATION: ACTUAL DEVICE INVOLVED IN INCIDENT WAS EVALUATED, VISUAL EXAMINATION. RESULTS OF EVALUATION: NONE OR UNKNOWN. CONCLUSION: NONE OR UNKNOWN. CERTAINTY OF DEVICE AS CAUSE OF OR CONTRIBUTOR TO EVENT: MAYBE. CORRECTIVE ACTIONS: OTHER. THE DEVICE WAS DESTROYED/DISPOSED OF.